Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol
Autor: | Jia Jun Ang, Dedrick Kok Hong Chan, Jarrod Kah Hwee Tan, Daryl Kai Ann Chia |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty Colorectal cancer 03 medical and health sciences Postoperative Complications 0302 clinical medicine Colorectal cancer surgery Internal medicine Humans Medicine Risk factor Aged Aged 80 and over business.industry Age Factors Soft diet Length of Stay Vascular surgery medicine.disease Cardiac surgery Elective Surgical Procedures Cardiothoracic surgery 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Surgery Colorectal Neoplasms Enhanced Recovery After Surgery business Abdominal surgery |
Zdroj: | Langenbeck's Archives of Surgery. 405:673-689 |
ISSN: | 1435-2451 1435-2443 |
Popis: | Elderly patients with colorectal cancer are high-risk surgical candidates. ERAS protocols have been developed to mitigate against these risks. We performed this study to quantify the risks which elderly patients face and then to determine independent risk factors for short-term ERAS-specific outcomes. An analysis of a prospectively collected audit database of all patients who underwent elective colorectal cancer resection within an ERAS framework from January 2018 to December 2018 was performed. Elderly was defined in our study as age ≥ 65 years. There were 172 elective colorectal cancer resections performed. Ninety-seven (56.4%) were elderly. Elderly patients were at increased risk of developing post-operative complications (33.0% vs 16.0%, p = 0.011), longer time to diet (3.4 vs 2.2 days, p = 0.001), and longer hospital stay (10.9 vs 6.7 days, p = 0.007). Independent risk factors were determined for the abovementioned three outcomes. Elderly status was the only risk factor for increased complications (OR 2.61 95% CI (1.05–6.51), p = 0.040). For delayed time to soft diet, male gender (OR 6.67(1.92–20.0), p = 0.002), open approach (OR 9.06(2.26–36.30), p = 0.002), and increased operative time (OR 1.01(1.00–1.01) p = 0.014) were risk factors. Finally, elderly age (OR 5.53(1.82–16.84), p = 0.003), leucocyte count (OR 1.39(0.76–2.57), p = 0.038), open approach (OR 5.26(1.41–19.62), p = 0.013), operative time (OR 1.01(1.00–1.01), p = 0.021), and Clavien-Dindo classification (OR 7.97(1.27–49.88), p = 0.027) were risk factors for prolonged length of stay. Elderly patients are intrinsically at risk for increased complications, longer time to soft diet and longer hospital stay. ERAS protocols may need to be specifically tailored for elderly patients. |
Databáze: | OpenAIRE |
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